MedTrainer

DECEMBER 7, 2023

All healthcare organizations, along with their providers and compliance officers, must understand the requirements of each regulatory state agency that provides oversight. Robust, flexible, and reliable compliance programs must be developed to maintain compliance in Hawaii.

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Compliance Compliance Officers Licensing Medicaid 52

AIHC

APRIL 10, 2024

Checklist for Individual & Small Group Practices Written by: Nancie Lee Cummins, CFE, CHA, CIFHA, OHCC, CHCM, CHCO, CORCM This article provides an overview of Health Information Technology for Economic and Clinical Health Act (HITECH) and basic checklist of policies and procedures for compliance of smaller health care organizations.

Compliance 52

Compliance US Department of Health and Human Services HIPAA Electronic Medical Records 52

MedTrainer

DECEMBER 7, 2023

Healthcare compliance in New Mexico mirrors the state’s diverse culture, with unique regulations that differ from other states, such as credentialing documentation requirements for managed care organizations. New Mexico’s parity law requires insurers to cover telemedicine services to the same extent as in-person services.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

MedTrainer

NOVEMBER 20, 2023

Managing healthcare compliance in Texas is nuanced and challenging. For successful compliance management in Texas, healthcare organizations need to develop a strong system for tracking and interpreting regulatory changes, and promptly adapt to these modifications.

Compliance 52

Compliance Licensing Public Health Governance 52

MedTrainer

NOVEMBER 27, 2023

Managing healthcare compliance in Ohio presents a unique set of challenges for compliance officers, healthcare professionals, and administrators. Organizations need to successfully navigate the regulatory landscape in order to provide efficient and ethical healthcare services, and to avoid consequences for non-compliance.

Compliance 52

Compliance Licensing Medicaid Medicaid 52

Bill of Health

MAY 22, 2023

The selections feature topics ranging from an analysis of government and industry investments for recently approved drugs, to a discussion of court decisions on mifepristone, and an examination of the added therapeutic benefit associated with the top-selling brand-name drugs in Medicare. Cliff ERS, Kesselheim AS, Rome BN, Feldman WB.

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Pharmaceutical Industry Medicare Medicare Medicaid 157

MedTrainer

SEPTEMBER 8, 2023

Maintaining compliance with healthcare regulations and standards isn’t just a legal requirement; it’s a crucial element in upholding patient safety, data security, and the overall integrity of healthcare practices. Hear more on compliance essentials from a panel of expert healthcare surveyors. Why Is Healthcare Compliance Important?

Compliance 52

Compliance HIPAA Medicaid Medicaid 52

YouCompli

FEBRUARY 22, 2023

Raising prices on your hospital’s chargemaster can also raise your level of compliance grief. Most federal healthcare payors such as Medicare and Medicaid reimburse most providers on a prospective basis. The CCR is determined by a hospital’s cost report that is reconciled with the local Medicare contractor.

Compliance 52

Compliance US Department of Health and Human Services Overpayments Overpayment 52

Medisys Compliance

MARCH 5, 2024

This article explores into the details of cardiology billing, offering insights into payer audits and reimbursement challenges in cardiology billing. This complexity is reflected in the coding and billing requirements set forth by government payers such as Medicare, as well as private insurance companies.

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Medical Billing Outsourcing Medical Billing Compliance Governance 105

MedTrainer

DECEMBER 7, 2023

To sail smoothly through the complex rules and requirements, you need a deep knowledge of the most essential aspects of healthcare compliance in Maine. A successful compliance program involves adaptability, comprehensive planning, and insight into key compliance factors, including credentialing requirements.

Compliance 52

Compliance Licensing Compliance Officers Medicaid 52

Healthcare IT Today

JUNE 29, 2023

The following is a guest article by Isaac Smith, Billing, Coding, and Reimbursement Specialist at Medcare MSO ASCs are types of medical facilities that are subject to stringent regulations. However, ASC billing practices must be followed to ensure proper reimbursement and regulatory compliance. Two other appendices apply to ASCs.

Compliance 52

Compliance Medicare Medicare Medical Billing 52

Medisys Compliance

JUNE 24, 2022

What’s a Medicare Administrative Contractor (MAC)? Its quite common for any provider to get confused while billing to Medicare for healthcare services, as they not billing to Medicare but to a MAC. In this article, we discussed about what is MAC and activities handled by all these contractors.

Medicare 52

Medicare Medicare Medical Billing Medical Billing Outsourcing 52

Medisys Compliance

JULY 13, 2023

Medicare recognizes the importance of diabetes self-management training and offers coverage for eligible beneficiaries. However, there are specific guidelines and conditions that need to be met for Medicare billing. Diabetes Education Billing Guidelines for Medicare Who May Furnish the Training?

Medicare 52

Medicare Medicare Medical Billing Outsourcing Health Outcomes 52

Healthcare IT Today

JANUARY 2, 2024

The following is a guest article by Marlena Herrera, Director at Protegrity Healthcare organizations are becoming more lucrative targets for hackers, as their data is rich with extremely sensitive information and is often susceptible to vulnerabilities. Healthcare’s most valuable data is their patient or policyholder data.

Compliance 69

Compliance US Department of Health and Human Services HIPAA Health Insurance 69

AIHC

MARCH 12, 2024

Written by the AIHC Education Department This article provides an overview of how the media and government are reacting to the potential of artificial intelligence (AI) and potential threats associated with this advanced technology. A Government-Commissioned Report Released February 2024 The U.S.

Ransomware 59

Ransomware Governance Compliance HIPAA 59

AIHC

MARCH 12, 2024

Written by the AIHC Education Department This article provides an overview of how the media and government are reacting to the potential of artificial intelligence (AI) and potential threats associated with this advanced technology. A Government-Commissioned Report Released February 2024 The U.S.

Ransomware 52

Ransomware Governance Compliance HIPAA 52

Medisys Compliance

MAY 19, 2022

The federal government, state Medicaid programs, and private insurers have expanded coverage for virtual health care services. During the COVID-19 public health emergency, any health care provider who is eligible to bill Medicare can bill for telehealth services regardless of where the patient or provider is located. Eligible services.

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COVID-19 Medicare Medicare Medical Billing 52

Healthcare Law Today

DECEMBER 15, 2022

The case asks whether the government has authority to dismiss an FCA suit after initially declining to proceed with the action, and if so, what standard would apply. Petitioner-Relator Polansky is a doctor and former consultant for Executive Health Resources (EHR), a company that submits claims to Medicare on behalf of health care providers.

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Governance Doctors Medicare Medicare 52

Healthcare IT Today

JANUARY 17, 2024

The following is a guest article by Ritesh Ramesh, CEO at MDaudit Safeguarding revenues in the coming year requires healthcare systems to proactively navigate an evolving landscape with cross-functional collaboration, technological innovation, and increased AI investments. healthcare organizations.

Compliance 102

Compliance Overpayments Overpayment Medicare 102

YouCompli

OCTOBER 26, 2022

Helping our clinical colleagues feel the urgency of compliance monitoring can be a huge challenge. And the Compliance team simply doesn’t have the clinical expertise to own the monitoring of these requirements. The review found providers often did not meet the Medicare billing requirements – a whopping 83 of 200 were in error.

Compliance 52

Compliance Compliance Officers Overpayments Overpayment 52

Medisys Compliance

JUNE 10, 2022

Medicare covers limited chiropractic services when performed by a chiropractor who is licensed or legally authorized to furnish chiropractic services by the State or jurisdiction in which the services are furnished. In this article, we shared coding guidelines and Medicare coverage for Chiropractic Manipulative Treatment (CMT).

Medicare 59

Medicare Medicare Medical Billing Medical Billing Outsourcing 59

Healthcare IT Today

NOVEMBER 15, 2023

The previous article in this series explained some of the ways payers, providers, and digital health companies demonstrate that they have made a positive difference in their patients’ lives. ” This article looks at the measurements and reporting strategies used by some specific companies. offering in-home treatment.

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Medicare Medicare Hospitals Compliance 94

YouCompli

JULY 26, 2023

Health and Human Services Office of Inspector General (OIG) found that Medicare beneficiaries used 88 times more telehealth services during the first year of the pandemic than they did the previous year. million in Medicare fee-for-service payments. billion in Medicare funds for orthotic braces in the 20 months that followed. 

Fraud 52

Fraud Compliance Medicare Medicare 52

MedTrainer

APRIL 20, 2023

One way to stand out and elevate your career is as a Certified Compliance and Ethics Professional (CCEP). In this article, we’ll walk you through the steps to help you navigate the path to CCEP certification and empower you to enhance your professional standing as you contribute to the growth and success of your organization.

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Compliance Medicare Medicare Governance 40

YouCompli

SEPTEMBER 13, 2023

Mitigating fraud, waste, and abuse (FWA) is taking on a new urgency for healthcare compliance professionals. Enforcement agencies are prioritizing efforts to deter FWA as more individuals enroll in government healthcare programs like Medicare and Medicaid, and telehealth services continue to evolve post-pandemic.

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US Department of Health and Human Services Compliance Officers Compliance Fraud 52

Hall Render

JULY 25, 2023

At first glance, different outcomes based on the same type of APP support program suggest contradictory views from the government. Special thanks to Antoine Neumann, summer associate, for his assistance with the preparation of this article. Hall Render blog posts and articles are intended for informational purposes only.

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Compliance Hospitals Governance Doctors 40

AIHC

NOVEMBER 29, 2023

We recommend reading Leadership in a Value-Based Care (VBC) Environment in addition to this article. Medicare changed reimbursement methodology in the 1980s by introducing Relative Value Units (RVUs) and the RBRVS (Resource-Based Relative Value System) for physician reimbursement. Why this Trend of Value-Based Care?

Medicare 59

Medicare Medicare Medicaid Medicaid 59

YouCompli

JULY 12, 2022

This month’s article looks at telehealth actions. In fact, Medicare beneficiaries used telehealth to receive 12 percent of their services during the first year of the pandemic. An initial report from the OIG also notes that, “over 28 million Medicare beneficiaries used telehealth during the first year of the pandemic.

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COVID-19 Medicare Medicare Telemedicine 52

YouCompli

JUNE 29, 2022

With it, compliance officers have guided their healthcare organizations in complying with changing documentation, coding, and confidentiality requirements. As virtual care requirements for telehealth evolve, we explore how compliance officers can support patient care and help their organizations stay up to date. the end of COVID-19.

Compliance Officers 52

Compliance Officers Compliance Telemedicine COVID-19 52

AIHC

NOVEMBER 29, 2023

We recommend reading Leadership in a Value-Based Care (VBC) Environment in addition to this article. Medicare changed reimbursement methodology in the 1980s by introducing Relative Value Units (RVUs) and the RBRVS (Resource-Based Relative Value System) for physician reimbursement. Why this Trend of Value-Based Care?

Medicare 52

Medicare Medicare Medicaid Medicaid 52

YouCompli

APRIL 13, 2022

This month’s article looks at beneficiary inducement actions. But tactics common in other industries might be considered illegal beneficiary inducements in healthcare, especially for beneficiaries of federal programs like Medicare or Medicaid. Deflated Medicare copayment and ‘courtesy adjustments’ for injections.

Medicare 40

Medicare Medicare Governance Compliance 40

Healthcare Law Blog

JANUARY 26, 2023

In this article we provide a brief summary of the Proposed Rule, while also examining the statutory amendments and previous rulemakings that create its foundation. BACKGROUND The Proposed Rule is the latest in a long line of federal legislation and rulemakings governing the conscience rights of healthcare providers and entities.

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ACA Medicaid Medicaid Compliance 105

MedTrainer

FEBRUARY 27, 2024

And like any healthcare professional, HHAs must adhere to the compliance standards that govern quality care. It is arguably more important — and harder — to maintain a standard level of compliance when staff are working in client homes, rather than in a central facility. What is the Role of Home Health Aides?

Compliance 52

Compliance HIPAA Fraud Licensing 52

AIHC

SEPTEMBER 5, 2023

Compliance Considerations for Best Outcomes Written in collaboration with the AIHC Volunteer Education Committee Delivering mental health services via telehealth has increased since the COVID-19 pandemic. This article is not intended as legal or consulting advice. This is also called “store-and-forward telemedicine.”

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COVID-19 Telemedicine Compliance Informed Consent 59

AIHC

OCTOBER 20, 2023

Part 1 in a Series of Leadership Articles on Value-Based Care Written by Joanne Byron, LPN, BS, CCA, CIFHA, CHA, COCAS, CORCM, CHCO, OHCC, CMDP, ICDCT-CM/PCS ​ Edited by Julie Rickman , MBA, CHC, CHPC, CHCO ​ This article is the first in a series sponsored by the American Institute of Healthcare Compliance (AIHC) Volunteer Education Committee.

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Health Outcomes Medicare Medicare Governance 59

AIHC

NOVEMBER 6, 2023

The focus of this article is to “connect the dots” between Health Insurance Portability & Accountability Act (HIPAA) and HITECH regarding privacy and security of electronically protected health information (ePHI). HITECH puts a “bite” into specific elements of the HIPAA rule, such as higher penalty amounts for non-compliance.

HIPAA 59

HIPAA Compliance Governance Health Insurance 59

AIHC

APRIL 5, 2022

Written by: AIHC Blogger This article provides educational information related to mitigating the risk of an unwarranted payer investigation. This is the final article in a 3-part series on denials and appeals management. Diagnosis codes are an important compliance aspect of reporting medical necessity on the claim.

Fraud 52

Fraud Compliance Medicare Medicare 52